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1.
PLoS One ; 15(10): e0241027, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-883688

RESUMEN

As the number of cases of COVID-19 continues to grow, local health services are at risk of being overwhelmed with patients requiring intensive care. We develop and implement an algorithm to provide optimal re-routing strategies to either transfer patients requiring Intensive Care Units (ICU) or ventilators, constrained by feasibility of transfer. We validate our approach with realistic data from the United Kingdom and Spain. In the UK, we consider the National Health Service at the level of trusts and define a 4-regular geometric graph which indicates the four nearest neighbours of any given trust. In Spain we coarse-grain the healthcare system at the level of autonomous communities, and extract similar contact networks. Through random search optimisation we identify the best load sharing strategy, where the cost function to minimise is based on the total number of ICU units above capacity. Our framework is general and flexible allowing for additional criteria, alternative cost functions, and can be extended to other resources beyond ICU units or ventilators. Assuming a uniform ICU demand, we show that it is possible to enable access to ICU for up to 1000 additional cases in the UK in a single step of the algorithm. Under a more realistic and heterogeneous demand, our method is able to balance about 600 beds per step in the Spanish system only using local sharing, and over 1300 using countrywide sharing, potentially saving a large percentage of these lives that would otherwise not have access to ICU.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Recursos en Salud/provisión & distribución , Modelos Teóricos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Algoritmos , Infecciones por Coronavirus/virología , Cuidados Críticos , Capacidad de Camas en Hospitales , Humanos , Unidades de Cuidados Intensivos/provisión & distribución , Pandemias , Transferencia de Pacientes , Neumonía Viral/virología , España/epidemiología , Reino Unido/epidemiología , Ventiladores Mecánicos/provisión & distribución
2.
Elife ; 92020 10 12.
Artículo en Inglés | MEDLINE | ID: covidwho-844205

RESUMEN

This study examined records of 2566 consecutive COVID-19 patients at five Massachusetts hospitals and sought to predict level-of-care requirements based on clinical and laboratory data. Several classification methods were applied and compared against standard pneumonia severity scores. The need for hospitalization, ICU care, and mechanical ventilation were predicted with a validation accuracy of 88%, 87%, and 86%, respectively. Pneumonia severity scores achieve respective accuracies of 73% and 74% for ICU care and ventilation. When predictions are limited to patients with more complex disease, the accuracy of the ICU and ventilation prediction models achieved accuracy of 83% and 82%, respectively. Vital signs, age, BMI, dyspnea, and comorbidities were the most important predictors of hospitalization. Opacities on chest imaging, age, admission vital signs and symptoms, male gender, admission laboratory results, and diabetes were the most important risk factors for ICU admission and mechanical ventilation. The factors identified collectively form a signature of the novel COVID-19 disease.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Necesidades y Demandas de Servicios de Salud , Pandemias , Neumonía Viral/terapia , Adulto , Anciano , Área Bajo la Curva , Índice de Masa Corporal , Comorbilidad , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Unidades de Cuidados Intensivos/provisión & distribución , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Dinámicas no Lineales , Neumonía Viral/epidemiología , Utilización de Procedimientos y Técnicas , Curva ROC , Respiración Artificial/estadística & datos numéricos , Factores de Riesgo , Ventiladores Mecánicos/provisión & distribución
3.
Respir Care ; 65(7): 920-931, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-840991

RESUMEN

BACKGROUND: The overwhelming demand for mechanical ventilators due to COVID-19 has stimulated interest in using one ventilator for multiple patients (ie, multiplex ventilation). Despite a plethora of information on the internet, there is little supporting evidence and no human studies. The risk of multiplex ventilation is that ventilation and PEEP effects are largely uncontrollable and depend on the difference between patients' resistance and compliance. It is not clear whether volume control ventilation or pressure control ventilation is safer or more effective. We designed a simulation-based study to allow complete control over the relevant variables to determine the effects of various degrees of resistance-compliance imbalance on tidal volume (VT), end-expiratory lung volume (EELV), and imputed pH. METHODS: Two separate breathing simulators were ventilated with a ventilator using pressure control and volume control ventilation modes. Evidence-based lung models simulated a range of differences in resistance and compliance (6 pairs of simulated patients). Differences in VT, EELV, and imputed pH were recorded. RESULTS: Depending on differences in resistance and compliance, differences in VT ranged from 1% (with equal resistance and compliance) to 79%. Differences in EELV ranged from 2% to 109%, whereas differences in pH ranged from 0% to 5%. Failure due to excessive VT (ie, > 8 mL/kg) did not occur, but failure due to excessive EELV difference (ie, > 10%) was evident in 50% of patient pairs. There was no difference in failure rate between volume control and pressure control ventilation modes. CONCLUSIONS: These experiments confirmed the potential for markedly different ventilation and oxygenation for patients with uneven respiratory system impedances during multiplex ventilation. Three critical problems must be solved to minimize risk: (1) partitioning of inspiratory flow from the ventilator individually between the 2 patients, (2) measurement of VT delivered to each patient, and (3) provision for individual PEEP. We provide suggestions for solving these problems.


Asunto(s)
Resistencia de las Vías Respiratorias/fisiología , Infecciones por Coronavirus , Rendimiento Pulmonar/fisiología , Ensayo de Materiales/métodos , Pandemias , Neumonía Viral , Respiración Artificial , Betacoronavirus , Simulación por Computador , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Diseño de Equipo , Humanos , Modelos Biológicos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Respiración Artificial/instrumentación , Respiración Artificial/métodos , Ventiladores Mecánicos/normas , Ventiladores Mecánicos/provisión & distribución
5.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 106-111, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-788983

RESUMEN

The respiratory disease caused by the coronavirus SARS-CoV-2 (COVID-19) is a pandemic that produces a large number of simultaneous patients with severe symptoms and in need of special hospital care, overloading the infrastructure of health services. All of these demands generate the need to ration equipment and interventions. Faced with this imbalance, how, when, and who decides, there is the impact of the stressful systems of professionals who are at the front line of care and, in the background, issues inherent to human subjectivity. Along this path, the idea of using artificial intelligence algorithms to replace health professionals in the decision-making process also arises. In this context, there is the ethical question of how to manage the demands produced by the pandemic. The objective of this work is to reflect, from the point of view of medical ethics, on the basic principles of the choices made by the health teams, during the COVID-19 pandemic, whose resources are scarce and decisions cause anguish and restlessness. The ethical values for the rationing of health resources in an epidemic must converge to some proposals based on fundamental values such as maximizing the benefits produced by scarce resources, treating people equally, promoting and recommending instrumental values, giving priority to critical situations. Naturally, different judgments will occur in different circumstances, but transparency is essential to ensure public trust. In this way, it is possible to develop prioritization guidelines using well-defined values and ethical recommendations to achieve fair resource allocation.


Asunto(s)
Toma de Decisiones Clínicas/ética , Infecciones por Coronavirus/epidemiología , Asignación de Recursos para la Atención de Salud/ética , Pandemias , Neumonía Viral/epidemiología , Triaje/ética , Inteligencia Artificial , Betacoronavirus , Infecciones por Coronavirus/terapia , Humanos , Neumonía Viral/terapia , Ventiladores Mecánicos/provisión & distribución
7.
Anesthesiology ; 133(4): 892-904, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: covidwho-772637

RESUMEN

BACKGROUND: During the COVID-19 pandemic, ventilator sharing was suggested to increase availability of mechanical ventilation. The safety and feasibility of ventilator sharing is unknown. METHODS: A single ventilator in pressure control mode was used with flow control valves to simultaneously ventilate two patients with different lung compliances. The system was first evaluated using high-fidelity human patient simulator mannequins and then tested for 1 h in two pairs of COVID-19 patients with acute respiratory failure. Patients were matched on positive end-expiratory pressure, fractional inspired oxygen tension, and respiratory rate. Tidal volume and peak airway pressure (PMAX) were recorded from each patient using separate independent spirometers and arterial blood gas samples drawn at 0, 30, and 60 min. The authors assessed acid-base status, oxygenation, tidal volume, and PMAX for each patient. Stability was assessed by calculating the coefficient of variation. RESULTS: The valves performed as expected in simulation, providing a stable tidal volume of 400 ml each to two mannequins with compliance ratios varying from 20:20 to 20:90 ml/cm H2O. The system was then tested in two pairs of patients. Pair 1 was a 49-yr-old woman, ideal body weight 46 kg, and a 55-yr-old man, ideal body weight 64 kg, with lung compliance 27 ml/cm H2O versus 35 ml/cm H2O. The coefficient of variation for tidal volume was 0.2 to 1.7%, and for PMAX 0 to 1.1%. Pair 2 was a 32-yr-old man, ideal body weight 62 kg, and a 56-yr-old woman, ideal body weight 46 kg, with lung compliance 12 ml/cm H2O versus 21 ml/cm H2O. The coefficient of variation for tidal volume was 0.4 to 5.6%, and for PMAX 0 to 2.1%. CONCLUSIONS: Differential ventilation using a single ventilator is feasible. Flow control valves enable delivery of stable tidal volume and PMAX similar to those provided by individual ventilators.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Respiración Artificial/métodos , Ventiladores Mecánicos , Equilibrio Ácido-Base , Adulto , Presión de las Vías Aéreas Positiva Contínua , Infecciones por Coronavirus/complicaciones , Estudios de Factibilidad , Femenino , Humanos , Rendimiento Pulmonar , Masculino , Maniquíes , Persona de Mediana Edad , Oxígeno/sangre , Pandemias , Neumonía Viral/complicaciones , Respiración con Presión Positiva , Respiración Artificial/instrumentación , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Espirometría , Volumen de Ventilación Pulmonar , Ventiladores Mecánicos/provisión & distribución
8.
Life Sci ; 257: 118113, 2020 Sep 15.
Artículo en Inglés | MEDLINE | ID: covidwho-652999

RESUMEN

AIMS: To create a low-cost ventilator that could be constructed with readily-available hospital equipment for use in emergency or low-resource settings. MAIN METHODS: The novel ventilator consists of an inspiratory limb composed of an elastic flow-inflating bag encased within a non-compliant outer sheath and an expiratory limb composed of a series of two, one-way bidirectional splitter valves derived from a self-inflating bag system. An Arduino Uno microcontroller controls a solenoid valve that can be programmed to open and close to produce a set respiratory rate and inspiratory time. Using an ASL 5000 Lung Simulator, we obtained flow, pressure, and volume waveforms at different lung compliances. KEY FINDINGS: At a static lung compliance of 50 mL/cm H2O and an airway resistance of 6 cm H2O/L/s, ventilated at a PIP and PEEP of 16 and 5 cm H2O, respectively, tidal volumes of approximately 540 mL were achieved. At a static lung compliance of 20 mL/cm H2O and an airway resistance of 6 cm H2O/L/s, ventilated at a PIP and PEEP of 38 and 15 cm H2O, respectively, tidal volumes of approximately 495 mL were achieved. SIGNIFICANCE: This novel ventilator is able to safely and reliably ventilate patients with a range of pulmonary disease in a simulated setting. Opportunities exist to utilize our ventilator in emergency situations and low-resource settings.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Neumonía Viral/fisiopatología , Respiración Artificial/instrumentación , Respiración Artificial/métodos , Resistencia de las Vías Respiratorias/fisiología , Betacoronavirus/patogenicidad , Humanos , Pulmón/fisiología , Pandemias , Frecuencia Respiratoria/fisiología , Volumen de Ventilación Pulmonar/fisiología , Ventiladores Mecánicos/provisión & distribución
9.
Salud Publica Mex ; 62(5): 590-592, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-621907

RESUMEN

On April 12, 2020, a bioethics guide for allocating scarce hospital resources during the current Covid-19 pandemic was posted on the website of the Consejo de Salubridad General(CSG) of the Government of Mexico. The guide, entitled Guía bioética para asignación de recursos limitados de medicina crítica en situación de emergencia, was intended as a preliminary document, but the website posting did not describe it as a first step in the process. The publicity resulted in a wide array of comments and criticisms. That first version posted on the CSG website contained an age-based criterion for breaking a tie between two or more medically eligible patients who needed of a ventilator: younger patients would have prefer-ence over older ones. The final version of the guide eliminated that criterion and instead, relied on the leading public health principle, "save the most lives", without regard to personal characteristics other than the possibility of benefitting from the scarce medical resources.


Asunto(s)
Discusiones Bioéticas/normas , Infecciones por Coronavirus , Recursos en Salud/provisión & distribución , Pandemias , Neumonía Viral , Guías de Práctica Clínica como Asunto , Asignación de Recursos/ética , Triaje/ética , Ageísmo , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Toma de Decisiones , Disentimientos y Disputas , Necesidades y Demandas de Servicios de Salud , Humanos , Esperanza de Vida , México , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Justicia Social , Triaje/normas , Valor de la Vida , Ventiladores Mecánicos/provisión & distribución , Privación de Tratamiento/ética , Privación de Tratamiento/normas
10.
Int J Health Geogr ; 19(1): 36, 2020 09 14.
Artículo en Inglés | MEDLINE | ID: covidwho-757061

RESUMEN

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD: The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS: The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION: Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.


Asunto(s)
Áreas de Influencia de Salud/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Recursos en Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Betacoronavirus , Accesibilidad a los Servicios de Salud/organización & administración , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Illinois , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pandemias , Factores Socioeconómicos , Análisis Espacial , Ventiladores Mecánicos/provisión & distribución
11.
Anaesthesia ; 75(8): 1022-1027, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-751832

RESUMEN

The COVID-19 pandemic has increased the demand for disposable N95 respirators. Re-usable elastomeric respirators may provide a suitable alternative. Proprietary elastomeric respirator filters may become depleted as demand increases. An alternative may be the virus/bacterial filters used in anaesthesia circuits, if they can be adequately fitted onto the elastomeric respirators. In addition, many re-usable elastomeric respirators do not filter exhaled breaths. If used for sterile procedures, this would also require modification. We designed a 3D-printed adaptor that permits elastomeric respirators to interface with anaesthesia circuit filters and created a simple modification to divert exhaled breaths through the filter. We conducted a feasibility study evaluating the performance of our modified elastomeric respirators. A convenience sample of eight volunteers was recruited. Quantitative fit testing, respiratory rate and end-tidal carbon dioxide were recorded during fit testing exercises and after 1 h of wear. All eight volunteers obtained excellent quantitative fit testing throughout the trial. The mean (SD) end-tidal carbon dioxide was 4.5 (0.5) kPa and 4.6 (0.4) kPa at baseline and after 1 h of wear (p = 0.148). The mean (SD) respiratory rate was 17 (4) breaths.min-1 and 17 (3) breaths.min-1 at baseline and after 1 h of wear (p = 0.435). Four out of eight subjects self-reported discomfort; two reported facial pressure, one reported exhalation resistance and one reported transient dizziness on exertion. Re-usable elastomeric respirators to utilise anaesthesia circuit filters through a 3D-printed adaptor may be a potential alternative to disposable N95 respirators during the COVID-19 pandemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Filtración/instrumentación , Neumonía Viral/terapia , Ventiladores Mecánicos , Adulto , Dióxido de Carbono/fisiología , Infecciones por Coronavirus/epidemiología , Elastómeros , Diseño de Equipo , Equipo Reutilizado , Estudios de Factibilidad , Femenino , Humanos , Masculino , Ensayo de Materiales/métodos , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Impresión Tridimensional , Frecuencia Respiratoria , Ventiladores Mecánicos/provisión & distribución
13.
BMC Res Notes ; 13(1): 421, 2020 Sep 07.
Artículo en Inglés | MEDLINE | ID: covidwho-745675

RESUMEN

OBJECTIVE: The advent of new technologies has made it possible to explore alternative ventilator manufacturing to meet the worldwide shortfall for mechanical ventilators especially in pandemics. We describe a method using rapid prototyping technologies to create an electro-mechanical ventilator in a cost effective, timely manner and provide results of testing using an in vitro-in vivo testing model. RESULTS: Rapid prototyping technologies (3D printing and 2D cutting) were used to create a modular ventilator. The artificial manual breathing unit (AMBU) bag connected to wall oxygen source using a flow meter was used as air reservoir. Controlled variables include respiratory rate, tidal volume and inspiratory: expiratory (I:E) ratio. In vitro testing and In vivo testing in the pig model demonstrated comparable mechanical efficiency of the test ventilator to that of standard ventilator but showed the material limits of 3D printed gears. Improved gear design resulted in better ventilator durability whilst reducing manufacturing time (< 2-h). The entire cost of manufacture of ventilator was estimated at 300 Australian dollars. A cost-effective novel rapid prototyped ventilator for use in patients with respiratory failure was developed in < 2-h and was effective in anesthetized, healthy pig model.


Asunto(s)
Diseño de Equipo/métodos , Respiración Artificial/instrumentación , Ventiladores Mecánicos/provisión & distribución , Anestesia General/métodos , Animales , Infecciones por Coronavirus/terapia , Volumen de Reserva Espiratoria/fisiología , Femenino , Humanos , Volumen de Reserva Inspiratoria/fisiología , Modelos Biológicos , Pandemias , Neumonía Viral/terapia , Impresión Tridimensional/instrumentación , Respiración Artificial/economía , Respiración Artificial/métodos , Frecuencia Respiratoria/fisiología , Porcinos , Volumen de Ventilación Pulmonar/fisiología , Ventiladores Mecánicos/economía
14.
S Afr Med J ; 110(9): 835-836, 2020 08 12.
Artículo en Inglés | MEDLINE | ID: covidwho-745266

RESUMEN

The stated objective of the COVID-19 lockdown was to allow time to prepare healthcare facilities. Preparation must include administrative and environmental measures, which when combined with personal protective equipment, minimise the risk of the spread of infection to patients and healthcare workers (HCWs) in facilities, allowing HCWs to safely provide essential services during the pandemic and limit the indirect effects of COVID-19 caused by healthcare disruption. We present our model for facility preparation based on colour-coded zones, social distancing, hand hygiene, rapid triage and separate management of symptomatic patients, and attention to infection transmission prevention between HCWs in communal staff areas. This model specifically addresses the challenges in preparing a facility for COVID-19 in a low-resource setting and in rural areas. In addition, we include links to resources to allow workers in low-resource settings to prepare their facilities adequately.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/organización & administración , Instituciones de Salud , Personal de Salud , Neumonía Viral/epidemiología , Instituciones de Atención Ambulatoria , Betacoronavirus , Creación de Capacidad , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Desinfección , Planificación Ambiental , Desinfección de las Manos , Hospitales , Humanos , Control de Infecciones , Unidades Móviles de Salud , Pandemias/prevención & control , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Sudáfrica/epidemiología , Ventiladores Mecánicos/provisión & distribución
18.
Chest ; 158(2): 603-607, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-683267

RESUMEN

Health systems confronting the coronavirus disease 2019 (COVID-19) pandemic must plan for surges in ICU demand and equitably distribute resources to maximize benefit for critically ill patients and the public during periods of resource scarcity. For example, morbidity and mortality could be mitigated by a proactive regional plan for the triage of mechanical ventilators. Extracorporeal membrane oxygenation (ECMO), a resource-intensive and potentially life-saving modality in severe respiratory failure, has generally not been included in proactive disaster preparedness until recently. This paper explores underlying assumptions and triage principles that could guide the integration of ECMO resources into existing disaster planning. Drawing from a collaborative framework developed by one US metropolitan area with multiple adult and pediatric extracorporeal life support centers, this paper aims to inform decision-making around ECMO use during a pandemic such as COVID-19. It also addresses the ethical and practical aspects of not continuing to offer ECMO during a disaster.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Enfermedad Crítica/terapia , Oxigenación por Membrana Extracorpórea/estadística & datos numéricos , Pandemias , Neumonía Viral/terapia , Triaje/organización & administración , Ventiladores Mecánicos/provisión & distribución , Salud Global , Humanos
19.
Respir Care ; 65(8): 1094-1103, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-680692

RESUMEN

BACKGROUND: The COVID-19 pandemic is creating ventilator shortages in many countries that is sparking a conversation about placing multiple patients on a single ventilator. However, on March 26, 2020, six leading medical organizations released a joint statement warning clinicians that attempting this technique could lead to poor outcomes and high mortality. Nevertheless, hospitals around the United States and abroad are considering this technique out of desperation (eg, New York), but there is little data to guide their approach. The overall objective of this study is to utilize a computational model of mechanically ventilated lungs to assess how patient-specific lung mechanics and ventilator settings impact lung tidal volume (VT). METHODS: We developed a lumped-parameter computational model of multiple patients connected to a shared ventilator and validated it against a similar experimental study. We used this model to evaluate how patient-specific lung compliance and resistance would impact VT under 4 ventilator settings of pressure control level, PEEP, breathing frequency, and inspiratory:expiratory ratio. RESULTS: Our computational model predicts VT within 10% of experimental measurements. Using this model to perform a parametric study, we provide proof-of-concept for an algorithm to better match patients in different hypothetical scenarios of a single ventilator shared by > 1 patient. CONCLUSIONS: Assigning patients to preset ventilators based on their required level of support on the lower PEEP/higher [Formula: see text] scale of the National Institute of Health's National Heart, Lung, and Blood Institute ARDS Clinical Network (ARDSNet), secondary to lung mechanics, could be used to overcome some of the legitimate concerns of placing multiple patients on a single ventilator. We emphasize that our results are currently based on a computational model that has not been validated against any preclinical or clinical data. Therefore, clinicians considering this approach should not look to our study as an exact estimate of predicted patient VT values.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Respiración con Presión Positiva/instrumentación , Ventiladores Mecánicos/provisión & distribución , Algoritmos , Betacoronavirus , Simulación por Computador , Infecciones por Coronavirus/epidemiología , Humanos , Pandemias , Neumonía Viral/epidemiología , Prueba de Estudio Conceptual , Mecánica Respiratoria
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